If you’ve ever had physical therapy for your balance you’ve probably stood on one of those squishy foam pads or been asked to stay steady as the PT (gently) pushes you around to test your balance – these are all methods of challenging your balance to specifically illicit a reaction, through which you work through stabilizing yourself.

Physical Therapists refer to terms like “anticipatory postural adjustments", "reaction strategy” and "recovery strategy" when dealing in balance to measure, assess and improve a person's ability to do this vital job. Each of these terms are important cogs in the wheel that keep you stable and without them you’d be pushed right over – whether maneuvering around the house for a daily task or driving through a crowded lane for a layup. And these balance components being better or worse are partially an indicator of risk for falls.

Your natural balance strategy was designed for you to stand through your legs, relying on input and strength from various systems that mostly involve your trunk/hip/ankle muscles, your vision, etc. Your body is designed to respond to triggers from these systems to do things like anticipate a shift in weight, react to a feeling of unsteadiness or recover from a loss of balance - all with the goal of self-stabilizing.

Walkers become an option if your natural balance is failing you. They exist to help the acutely injured, chronically disabled, and older adult across every tier of our healthcare system by relying on a basic principle of leaning on support through your hands to help stabilize yourself. This can be a valuable necessity to stay mobile and walking around but it is new for your body, as normally you might be used to using your arms and hands to do things while walking like take a sip of coffee or wave to a friend - not lean through them for support. Adding this element of leaning weight through your hands clouds your body’s ability to judge its balance naturally by doing part of its job for it.

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There's a lot to potentially unpack here but let's focus on the issue it presents when you become unsteady while using the walker. If now you’re keeping your balance by (at least in part) leaning on your hands, which again your body isn’t naturally used to, your balance reaction times could suffer which means there's a delay in how quickly you notice any unsteadiness and react to stabilize. It's also not uncommon to become used to leaning on the device over time and fail to regularly challenge your natural strategy, depressing it and impacting reaction times further.

Where this becomes particularly important is during a scenario where your walker tips. Consider A) you don’t have the best balance in the first place, B) you’re in a habit of leaning/pulling through your hands to stay stable and C) the device you’re relying on to stabilize you is itself now unstable. Once your natural balance does kick in – you AND the device that’s supposed to be supporting you are now both off balance. Trying to adjust in that scenario is much harder. It’s like pulling on a rope in tug of war as the other team let’s go – very tough to stay on your feet.

Walker tipping is a frequent issue with acute and chronic walker users alike – why does it happen? In many cases it might just be part of the struggle to stay upright that goes hand in hand with whatever has you needing a walker in the first place. In some cases the tipping itself may be more an indication of a lack of that natural strategy.

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We know that relying on a device is not ideal whenever it can be avoided, but we also know the necessary benefits when it's required which is why walkers are vital pieces of equipment for many. Given this - how do we design devices that better work with your natural balance strategy? Is there a way to take the added variable of leaning through your hands and blend it better with your body's natural strategy to more successfully anticipate or begin to correct sooner? Or keep the device from tipping in unstable scenarios to mitigate the struggle to stabilize?

These are the types of questions we’re asking in our design of SmartStep. Please check us out!

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